Medically unexplained symptoms across cultures

Medically unexplained symptoms occur across all cultures. Their presentation and resulting pathways into care are strongly influenced by cultural explanations and idioms of distress. Pathways into care are followed depending upon explanatory models and health care systems. In many West European and Anglo-centric countries people presenting with somatic symptom representing psychiatric distress are known as somatisers and often seen as being inferior as they are not able to express distress in psychological terms. The incipient danger in such an approach is that clinicians forget to follow the explanatory models of their patients or their carers and families. These models of explanation are strongly influenced by the understanding of illness. In many countries, traditional models of illness do not follow strict mind-body dualism thereby creating an inherent and strong link between physical and psychiatric symptoms. These variations across cultures affect not only help-seeking but also pressures on health systems. A clear understanding of these models can help services to be planned in an efficacious and accessible way. Variations in rates have to be looked at in the context of cultural variations. It is important that clinicians are aware of how patients present, what their expectations and what is needed to deliver interventions which are acceptable.